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Wednesday, January 25, 2012

Oh, the places I've pumped! (and other nursing adventures)

Nursing for me has been, as the title suggests, an adventure. Part Lord of the Rings, part Dr. Seuss. (And guys, don't be intrigued by the analogy: these are my no-holds-barred reflections on nursing, that you probably don't really want to read. You've been warned!)

Part Lord of the Rings: the commitment of knowing you are doing the best you can for the greater good (baby's health), the treachery of obstacles and enemies (sore nipples, plugged ducts, baby deciding at 5.5 months that he does not want to be in any of the nursing positions...for several weeks), the thrill of success (like at 3.5 months when it became comfortable and easy or at 4 months when everything got faster and more efficient or at a year when I've met my goal in spite of many thoughts of quitting).

Part Dr Seuss: Oh the places I've pumped...a silly list that I will get to at the end. Or just skip the gory details and read the funny list.

My nursing adventure has been a blessing--one of my most heartfelt and earnest prayers while pregnant was that I would be able to nurse--but it has not been easy. I tell my story to encourage, not discourage. To say I feel for the many moms who have struggled with or are struggling with this. I am so thankful to the Lord to have made it this far. If you are considering nursing, my story won't lull you into a blissful dream world. Many women DO have a dream world experience, and I hope you do, too. If you are nursing and run into one of many potential obstacles, I hope my story inspires you to keep going, to seek the help that's out there, to remind you someone in this great big world has been there.

My story starts with a sweet eight-pounder that loves to eat. He caught on quickly to nursing. During our first nursing session, we did skin to skin. It was beautiful, awkward, exciting with a twist of anxiety and a dose of joy.

That beautiful and exciting introduction opens to the rest of the story (best arranged topically, rather than chronologically):

The super suck (pun intended) aka sore nipples: Though our Lamaze class told me to, I did not insist on a good latch on one side during that first nursing session. Naive first-time mom--I thought he must be so hungry that I did not want to break the latch to reset him (silly), so I started out very sore on one side and somewhat sore on the other.

Our lactation consultant at the hospital was very helpful. We practiced a couple holds, and she helped me adjust his latch. It was obvious that he was able to get a lot more milk that way, and he became even more interested. Though everyone said that nursing is not supposed to hurt, I struggled with soreness. My ob/gyn said that she experienced a few seconds of soreness each time her son latched on for the first two weeks. I experienced soreness for the first few months.

Our hospital had a lactation support session twice a week, which was great. I went up there two or three times, so they could watch how Gavin was nursing and give me tips. They also weighed him before and after the nursing to see how much he was taking in. It was really helpful to get some pointers, but for the most part, they said he was latching on well. I decided that maybe he just had a really vigorous suck.

And then at about 3.5 months, I just kind of noticed, "Hey, this doesn't hurt anymore." It was great!

A faster let-down is not a let-down: At about 4 months, my let-down reflex got more efficient and nursing got a lot faster. I had no idea to expect that, and I thought that he was pulling away because there wasn't enough milk in there. My friend whose daughter is 3 months older said she had the same experience and then learned that the let-down reflex had gotten more efficient. That shed a lot of light on the subject!

Bubbles are trouble: Our little guy has always had trouble getting the burps out, and they have been very disruptive to his eating and his happiness. When he was tiny and still pretty stationary (1-5 months) we would work and work to get those burps out. When his second word after "Da-Da" was "burp," we realized we must have been pretty vocal in our coaching. The many techniques that we picked up are for another blog post, but here I want to focus on how it affected nursing.

That first night, we were settled in our room in the hospital. I was nursing him for probably the third time of his little life. He would start to suck and then turn away. He had been giving hunger cues, so I asked a nurse to come in and help me. She wasn't a lactation consultant, but we were blessed that our hospital was "breastfeeding certified," so everyone was very helpful and supportive. Anyway, when she saw what he was doing, she picked him up, burped him, and gave him back to me. He drank beautifully. So thankful for her! An aha moment.

In addition to burps, Gavin also always had a problem with spitting up. The books and the docs said that if it wasn't bothering him, it was okay, and that some babies spit up more than others, but as long as he was gaining weight and happy, there was nothing to worry about. Unfortunately, at about 5 months, it started to bother him. He would tense up or wince when he burped. The doctor said that the acid coming up was hurting him. He would often be very fussy when nursing, but less so with a bottle of breast milk. We tried probiotics (Baby Jarrodophilos), various feeding positions, a stiffer nursing pillow ("My Brest Friend" instead of "Boppy") and other tactics, and it kept getting worse. He would want to nurse, but then jerk away. It was pretty awful. We moved to Baby Zantac and then Baby Prevacid--still barely a difference.

The refusal to nurse peaked when Gavin was 6 months and my husband was in London for 10 days. So there I was, by myself with a hungry, uncomfortable, crying baby. At that point, my milk supply was very plentiful and the fact that he did not want to eat created real problems for me. When he wouldn't eat from me, I would get a bottle of expressed milk from the refrigerator, feed him and then try to occupy him in the exersaucer or with toys while I pumped. I was so blessed that my sister lived close and my mom was always willing to drive over and help, so sometimes, they would play with him while I pumped. Eventually, I just quit trying to nurse him during the midday feedings, and instead, I pumped while he was napping and then gave him the bottle of expressed milk. I didn't want to do it that way, but it was better getting stuck with full boobies and a hungry baby while trying to make a bottle and pump.

At the time I wasn't sure if it was an option for babies, but I told my doctor that the #1 thing that worked for my acid reflux was supplementing with digestive enzymes. Though she hadn't heard of that, she so kindly looked up a baby-safe digestive enzyme that she recommended to me (Transformation's Powdered Digestymes -- you can get them through www.pureformulas.com, which has great prices and free shipping). I was impressed at her client-centered professionalism--not always easy to find in the medical field. We started using them during a 12-day trip to Colorado, and by the end of the trip, we tried nursing during a midday feeding, and he did great!

The pump: What can I say about the pump? When I
started this entry, I was just giving up the 10:30 pumping that I used
to need to keep from getting too full overnight. Though I am so happy to see the pump go, I have to say, it's pretty amazing. Mine was hospital grade, and I could pump both sides at once hand-free. Since I knew I was going back to work and would have to pump multiple times each day, I went for the Cadillac model at the time (Medela Freestyle), of which my mom said, "That costs as much as a couch!" It was worth it.

In the
early days with sore nipples, the pump gave me a break from his super suck. Later, it allowed me to keep giving him breast milk even though I had to
go back to work (with a 45-minute commute, there was no "running over to
nurse him"). It got me out of quite a few jams when Gavin refused to
take from the breast, and it was a lifeline when we were trying to
figure out his acid reflux.

However, it also (I believe) led to--or if not led to--exacerbated
two problems: plugged ducts and oversupply. I do believe I probably
would have had the first problem to some degree even without the pump.
My milk seems really thick, and some people just have more problems with
that than others. I did get them a couple times even when he was
nursing from the breast (especially if he was sleepy). The plugged ducts caused me to
very cautious that I pump until I was completely empty (using heat and massage to help with that). I think my vigilance sent a message to my body to make more
milk, so I ended up with lots of milk. Sometimes on the weekends, I
would have to pump after he ate because I had more milk than he needed. Toward the end of this post, I list some general breastfeeding resources, as well as help that I found for plugged ducts.

When I quit my full-time job to work from home part time as a consultant, my sister would still
keep Gavin 2.5 days a week, and I would pump while he was with
her. After he started taking from the breast again, I would go
over there and nurse him. She lives close, so it was just as fast as
setting up, using and washing the pump. It was at that point that my
life became SO happy because my milk supply could finally take its cues
from him, and it balanced out to meet his demand. Hallelujah!

Mix up - Milk down: When Gavin was 10.5 months, I switched pharmacies and when I asked them to transfer my birth control pills from the old pharmacy to the new, they transferred the real pill (that I was taking before we started trying to get pregnant) instead of the mini-pill that my doctor prescribed after I had Gavin. Why? I do not know, but since generics are usually subbed for the brand name, and the brand names are always getting discontinued or changing names, I didn't realize it. About two weeks after I started the new pack, my milk production started to decline -- it took longer to let down, and I could tell by the suck to swallow ratio and time on the breast that he wasn't getting as much. I assumed that it was because he was getting older and more interested in food and that as he nursed less and less, my body was responding.

He was 11 months old at this point. I was planning to start weaning at one year, so I was bummed that my milk was going down earlier. One of my concerns was that I wasn't sure how he would take formula, and I knew I couldn't give him cow's milk until he turned one year. We introduced the formula in a sippy cup after a 3pm feeding. He drank the first ounce so fast, I'm convinced that he did not taste it until he took the cup out of his mouth, and then he made a face like, "Ew, whoa!" He drank more, but he was not thrilled. I kept offering it throughout the feeding, and he would take sips. After two more days, he was great with it.

So after several days of it taking a very long time for my milk to let-down and of me having very little milk at the 3pm feeding, we dropped that one. It was hard because I was worried that he wouldn't adjust well emotionally. He was at my sister's that day by design (out of sight, out of mind), so I told her to give him extra cuddles. He did just fine. I was fine, too. I was sad that I wasn't able to completely meet my goal, but I did not mind the freedom of not going to my sister's to feed him at that time. It made me think that I could continue with the other three feedings for a lot longer after he turned one than I had originally thought.

So, thinking I was on the mini pill and wondering if I was nursing enough for the mini pill to be effective, I called my OB/GYN. She asked me the name of the pill and told me that they had given me the real pill. By this time, I was on week 3 of the pack, so she advised that I finish the pack, and then go back to the mini pill.

During this time, I kept pumping at 10pm (like I had been since he dropped that feeding way back when). I used to get 4 to 6 ounces at that pumping, and I was now only getting 1 to 3. Even though there was such little milk, I decided not to give the pumping up because I did not want the lack of demand to make my milk supply decrease further. Plus, that was a few more ounces I could mix with a little cereal before bed for extra nutrition. After I got on the mini pill, my milk increased slightly but not dramatically. A few days before his birthday, I dropped the 10pm pumping because it was messing up my ducts. I can't really explain it: they would get lumpy but not really clog. Due to my long and ugly history with plugged ducts, I didn't want to chance it, so after a few nights of that, I happily gave up the pumping. I was nervous about clogs from not doing it, but I just applied heat before bed, and it worked out fine. I was so thankful to the Lord.

A few weeks after he turned 1, we dropped the 11am feeding for the same reasons we dropped the 3pm. Now I was thinking, maybe I'll just keep these two feedings (6:30am and 6pm) for a long time. It wasn't cumbersome, and I think we both enjoyed the bonding.

Then...I got another plugged duct. I couldn't believe it at first, but then I realized I had missed a couple nights of taking my lecithin (see more on lecithin below). Ugh. At first I thought, that's it -- he's older than a year, and I'm ready to give this up. But the more I thought about it, the more I realized--even with the plugged duct--I wasn't ready to give up those last two feedings. I made up my mind to start and finish another pack of the mini pill, and then get on the real pill which would decrease my milk supply and likely lead to weaning over the next month of so.

And then today happened...I got mixed up on my times and ended up giving him solid foods before nursing at dinner time (6pm). Not ideal, but I thought--no big deal--we'll just nurse before cereal (7:30ish). During the meal, he kept reaching for me across the table and whimpering. We thought he wanted what was on my plate. Then after we cleaned him up and let him play, he continued whimpering and looking distressed. Then I thought that maybe he wanted to nurse. Sure enough, that was what he wanted. I thought that we would be able to drop the first and last feedings as easy as the two midday ones, but at least for now, I do not think that is the case. Those two are not hard on me, so I plan to continue as long as he's interested and probably reevaluate at 18 months.

If you have finished this entire post, my guess is you are looking for resources on nursing. I've heard a lot of people say that they thought it was supposed to be a natural thing, so when it wasn't working they decided it wasn't for them or suffered through with an uncomfortable condition. There are lots of resources out there, so if this is something that you want to do, I hope you will take advantage of them. Here are some I found helpful:

www.kellymom.com - This website has answers to all kinds of questions: Is it safe? Latches and holds? Plugged ducts? Weaning? It was even recommended to me by the breastfeeding nurses at the hospital.

Our Lamaze class and the book they gave us called Breastfeeding - It was all so foreign to me that I practically memorized the section on proper latching and positioning, and I referenced other parts many times.

Your local hospital - I never went to a La Leche League, but my local hospital has a Lactation Support Class that I mentioned above and also a Q&A phone service open during business hours. I probably wouldn't have made it if it hadn't been for them.

I also wanted to share what helped me when dealing with plugged ducts. I know most people do not have as big of a problem with it as I did/do. I guess some people are more susceptible. Nothing cured the issue forever, but here is what helped*:

Emptying completely - especially when pumping. I used gentle massage to help with this. Or sometimes, I would gently press on one area until milk no longer flowed (yes you have to watch the nipple for this) and then move to another area and do the same.

Lecithin supplements - I took these two times a day when it was really bad and continued to take them once daily as a preventative.

Heating pads before nursing - Sometimes I would also use them throughout the day if the plugs were really bad. Other times heating without nursing made it (slightly) worse. I would experiment with it and see what works for you. I liked the NUK Warm or Cool Relief Pads. I can't say how many restaurants stuck them in their microwaves for me when we were on the go...

Advil - not as a preventative, just when I had a plug. Check with your doctor about when/if it is safe to take this or any drug while pregnant or nursing.

Though I never tried it, I read about ultrasound therapy helping with plugged ducts. It was difficult to find a place that did it, but if you are encountering plugged ducts, it might be worth a try. When I was in Colorado in the summer, I was trying to find a place that was familiar with it. I cannot vouch for them in any way because I never actually went there, but I did talk with Physiotherapy Associates (http://www.physiocorp.com). They sounded very familiar with the procedure, and they have offices in many parts of the U.S. I made an appointment, but then cancelled because the plugged duct was healed. When I cancelled, the therapist who would have done the procedure called me back to make sure I was okay and to make sure I knew how to resolve plugged ducts in the future. So kind!

* This is just my experience. Please check with your doctor or someone who actually went to school for this before moving forward with any option.

I am so thankful that I have been able to nurse Gavin. There were many trials, many sweet times (and as he grows, it just gets sweeter) and many funny situations, including...

Oh, the places I've pumped:

Standing up in the restroom at the United Way, where I often hosted meetings for my job. I did this many times before I learned that they have a small room that they would let me use...the power of asking.

Sitting in the comfy, though dimly lit, restroom at RDG (a restaurant), which had to be the best place. There was a sink, wicker chair, table in the "stall," or should I say, small room.

Gate C43 at the Denver International Airport.

In the car both moving and not moving, but not while driving, at least not that I remember.

In a restroom with motion sensitive lights. This was actually the second time I pumped away from home. Not remembering they were motion sensitive, I thought I was so lucky that no one came in while I was pumping in one of the stalls until, just as I was finishing, the lights went off. So, I was in the dark, trying to unhook the pump without spilling the precious milk. I dropped one lid on the ground and decided: it's time to try to activate the motion sensor, which is by the door, and of course, I'm in the furthest stall. I'm sure I looked ridiculous running out there half-dressed and waving my arms, but I did get the lights to come on. I did not spill the milk. I did not pump in that restroom again.

While on a conference call or two (Them: Do you hear a strange noise in the background? Me: Um, I'm not sure...)

In countless vacant offices or classrooms or conference rooms (including daily in my office, of course)

My final "place" is actually a nursing place, not a pumping place, but I have to share it anyway. On the fourth of July, I went to visit my sister for the first time after Gavin was born. She lives two hours away, so the trip required careful coordination in order to accommodate his feeding and napping schedule. Josh was in London for his PhD program, so I was going on my own. Everything was fine, until on the way home, we hit insane traffic. Like come-to-a-complete-stop-for-more-than-15-minutes-and-barely-moving-after-that traffic. When it was time to feed him, I was still an hour away from home. The one person I know well on that side of town wasn't home, so my mind was racing...what could I do? It was way too hot to feed him in the car. It was during that time in his life, where it was hit or miss whether he would nurse well or pull away because of the acid reflux, so I didn't want to take him to a noisy restaurant on the fourth of July. I began wondering if a hotel would let me nurse in a vacant room. I figured it wouldn't hurt to ask, and if not, I could always try the lobby if it was not too crowded and noisy. So I pulled up to a nice, new (and huge) Best Western -- hoping they would be friendly and down to earth. I explained my situation and made a brief but heartfelt plea. The wonderful person at the desk said yes! AND Gavin nursed well. I was so relieved. I asked the person who helped me what I could do, and she suggested a positive comment card mentioning her name, which I did happily.

1 comment:

One other nursing "resource" that I found out about right before Gavin was weaned:

A store clerk at Motherhood Maternity said that if I needed to pump or nurse in the dressing room, just ask. Their clothes are not my favorite, but I did get a few great nursing bras there, and pumping in the dressing room definitely would have beat doing it in my car! I'm not sure if all their stores have the same policy, but it's worth an ask.